Healthcare Provider Details

I. General information

NPI: 1952211864
Provider Name (Legal Business Name): CASEY DAWN GASBARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 NUN DR
CRESTVIEW FL
32536-4276
US

IV. Provider business mailing address

152 NUN DR
CRESTVIEW FL
32536-4276
US

V. Phone/Fax

Practice location:
  • Phone: 850-865-1513
  • Fax:
Mailing address:
  • Phone: 850-865-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW21876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: